Device for effecting temporary sterilisation

ABSTRACT

A surgical device for effecting temporary sterilisation of females by binding the Fallopian tubes is described, which instrument comprises a barrel and an implement at the distal end thereof and which can be operated from the proximal end thereof. In accordance with the invention, the implement referred to consists of a pair of grips which have arms openable and closable and curved so as to be able to surround a Fallopian tube: a passage is provided through the barrel to receive a binding element such as a thread or other filament, or a strip, and this binding element passes through the gripping arms when they are in their normally closed state. Preferably, although not necessarily, the passage referred to begins and ends in the proximal section of the instrument.

llnited States Patent [191 Semm [ June 28, I974 DEVICE FOR EFFECTINGTEMPORARY STERILISATION [76] Inventor: Kurt Sernrn, He gewischstrasse 4,

2300 Kiel, Germany [22] Filed: June 29, 1973 [21] Appl. No.: 374,894

[30] Foreign Application Priority Data Jan. 9, 1973 Germany 2300840 [52]US. Cl. 128/326, 128/346 [51] Int. Cl.. A6lb 17/30, A61b 17/10, A6lb17/12 [58] Field of Search 128/346, 326, 327, 334 R,

[56] References Cited UNITED STATES PATENTS 2,595,086 4/1952 Larzelere123/326 2,856,933 10/1958 Hildebrand et a1..... 2,940,451 6/1960Vogelfanger et al 128/334 R 3,506,012 4/1970 Brown 128/346 3,665,9265/1972 Flores 128/326 FOREIGN PATENTS OR APPLICATIONS 11/1934 GreatBritain 128/326 Primary ExaminerAldrich F. Medbery [5 7 ABSTRACT Asurgical device for effecting temporary sterilisation of females bybinding the Fallopian tubes is described, which instrument comprises abarrel and an implement at the distal end thereof and which can beoperated from the proximal end thereof.

In accordance with the invention, the implement referred to consists ofa pair of grips which have arms openable and closable and curved so asto be able to surround a Fallopian tube: a passage is provided throughthe barrel to receive a binding element such as a thread or otherfilament, or a strip, and this binding element passes through thegripping arms when they are in their normally closed state. Preferably,although not necessarily, the passage referred to begins and ends in theproximal section of the instrument.

7 Claims, 2 Drawing Figures DEVICE'FOR EFFECTING TEMPORARY STERILISATIONclips around the Fallopian tube which is to be blocked and finally tomake a tube ligature by pinching the Fallopian tube by closing theclips.

In practice it has proved that, due to the fact that the diameter of theFallopian tubes may differ widely from case to case, one size of clip isnot sufficient to deal with all the cases which may arise and thattherefore clips of various sizes must be held in readiness in order tohave a suitable size of clips available to match the dimensions of theFallopian tube to be tied off. Of course, the use of clips of differentsizes leads to the further disadvantage that appropriate appliances orgrips arev required for each size of clip. It will be appreciated thatthe result of this is a large and costly kit of instruments.

A considerable difficulty is caused by the fact that the clips mustnecessarily be applied to the Fallopian tubes in a position where it ishard to see them and that it is therefore extremely difficult in thecourse of the operation to estimate the position of the clips at anygiven time relative to the Fallopian tube, even when using endoscopictechniques. Therefore, it is not usually possible to check before thetube ligature is actually made whether the clips will, in fact,completely surround and shut off the Fallopian tube. It is thus selfevident that a sterilisation operation of this kind is unable to offeroptimum protection against unwanted pregnancies.

It is, therefore, an object of the invention to remove or minimisethedisadvantages referred to and to provide a devicewith which it ispossible to make a reliable ligature on the Fallopian tubes in a simplemanner.

Accordingly, the invention consists in a device of the kind described,wherein said implement consists of a pair of grips the arms of which arecurved so as to be able to surround a Fallopian tube, and wherein apassage is provided to receive a binding element which passes throughthe normally closed arms of the grips. The passage preferably begins andends in the proximal section of the device. The binding element may takeany desired form, for example it may be a thread or a strip.

The passage for the binding element may be formed in the interior of twosimilar or, substantially similar tubes passing through the barrel ofthe device, the distal ends of which are curved to form the arms of thegrips. When the implement is closed, the arms exert an outwardlydirected tension and are displaceable in relation to an annular partwhich partly encloses them and which bears against them externally. As aresult of the construction, depending on the direction of movement, itis possible to open and close the implement as a result of moving theannular part in relation to the arms of the grips.

In order that the invention may be more clearly understood, referencewill now be made to the accompanying drawings showing two embodimentsthereof by way of example and in which:

FIG. 1 shows a partial longitudinal section through a complete deviceaccording to the invention, and,

FIG. 2 shows a second embodiment, to an enlarged scale, of implementprovided at the distal end of the device.

Referring now to the drawings, the device shown consists of an elongatedbarrel 1 the outer diameter of which is such'that it can be insertedinto the abdomen through a trocar cannula, in pelviscopy for example. Atthe distal end of the device is situated an implement referred togenerally at 2, which is in the form of a pair of grips which are shownin the drawings as normally closed grips and having two arms 3a and 4awhich are curved such that any Fallopian tube encountered in practicecan be completely surrounded by the arms. To this end, the two closedarms form approximately a semi-circle at the outer end and pass fromthis pronounced curvatureinto a parallel configuration in the barrel 1so that, seen as a whole, the implement when closed has somewhat theshape of a noose.

The ligature on the tube is to be constituted by a binding element suchas a thread, or strip, which poses the problem of bringing such elementto the point at which the operation is performed, without excessivecomplication if possible. For this purpose the device is provided with apassage 5 into which and through which the binding element may be drawn.The passage 5 is indicated in FIG. 1 by a broken line. It extendsthrough the device from the proximal end thereof, then through thenormally closed gripping arms 3a and 4a and finally terminates back atthe proximal end of the device.

In the embodiment the passage 5 is formed in the interior of two similaror substantially similar tubes 3, 4 which extend through the barrel ofthe device 1 and whose distal ends are curved to produce the grippingarms 3a, 4a. The closed gripping arms may rest flat against one anotheror, for better mutual guidance and alignment, they may also partlyinter-engage. Whatever else happens, it should be ensured that thecavities in the gripping arms which form part of the passage 5 arealigned with one another at the point of division 6. As

will be explained below, the gripping arms must be capable of beingspread apart or opened after the introduction of the binding elementinto the passage 5.

This may, for example, be readily and simply achieved mechanically. Onerelatively simple possibility, applicable to the device shown, may befor the gripping arms to be made to exert an outwardly-directed tension,and, in relation to the drawing in FIG. 1 upwards and downwards, whichmay be achieved in a preliminary operation by appropriate deformation oftubes 3 and 5. It is then necessary for there to be a circular memberwhich encloses at least part of the gripping arms externally and whichcan be displaced relative to implement 2 so as to close the implementwhen displaced in one direction and to open the implement with theassistance of the spring-loading when displaced in the other direction.

In the present case the distal end of the barrel 1 forms the annularpart which bears against sloping faces on the gripping arms 3a, 4a,while the movement of the barrel 1 relative to the implement 2, which isrequired for the implement to operate, is achieved by fixing both tubes3, 4 in a mounting 7, which may be cylindrical for example, and which ismovable telescopically inside the barrel 1. It may readily be seen fromthe view shown in FIG. 1 that when the mounting 7 is moved to the leftthe implement 2 is opened and that when the mounting is moved in theopposite direction the implement closes.

In the embodiment shown, the displacement mentioned may take place inopposition to a spring 8, one end of which is fastened to the barrel 1and the other end of which is fastened to the mounting 7 and which ispre-tensioned such that in its normal position it attemps to withdrawthe tube-mounting 7 from the barrel 1. It is thus automatically ensuredthat the implement 2 is in the closed position in this normal state,since the gripping arms which bear internally against the distal end ofthe barrel are pressed towards one another.

The spring 18 is made of spring material in strip form and is formedinto a gentle curve with parallel or approximately parallel sides, as aresult of which it can, at the same time, be used as a handle foropening the gripping arms. The opening of the implement is achievedsimply by pressing the two sides of the spring together. When the springis released it automatically returns the implement to the normal, closedposition.

The procedure for making a ligature on the Fallopian tubes with thedevice described is as follows. The device is inserted into the abdomenthrough a trocar canula and its distal end is brought up to theFallopian tube to be provided with the ligature. The implement 2 isopened by compressing the spring or handle 8. The Fallopian tube is thencompletely surrounded by the gripping arms when the handle issubsequently released. This process may be continuously monitoredthrough an endoscope which is introduced into the abdomen through asecond incision. A non-absorbable, surgical binding thread is then drawnthrough the passage 5, the beginning and end of which are situatedoutside the body, by means of a suitable path-finding probe. After theinsertion process, the thread runs, for example, through tube 3, throughgripping arm 3a into gripping arm 4a and thence finally back throughtube 4 to the proximal end of the device. The thread thus also runsaround the Fallopian tube enclosed by the gripping arms. If the deviceis now withdrawn from the trocar cannula after the implement 2 has beenopened, the binding thread is held back by the part of the thread whichis now looped directly around the Fallopian tube and which causes thethread to be extracted from tubes 3 and 4. The two ends of the bindingthread hanging from the trocar cannula may be used as a guide for apinching member, such as a deformable ring for example, which is to beconveyed to the point of operation and by which the thread surroundingthe Fallopian tube is so secured after it has been drawn tight that theFallopian tube is securely tied off and sealed. To conclude theoperation the superfluous ends of thread are cut off and removed.

The device according to the invention provides a considerably higherdegree of reliability as regard effective tube ligature in comparisonwith the clip method mentioned initially. This degree of reliability iscomparable with that achieved in a conventional operation where theabdomen is opened. Furthermore, the temporary sterlization can bestopped at any time as desired by removing the loop of thread closingoff the Fallopian tube.

As a modification to the tubular gripping arms shown in FIG. 1, theycould alternatively be so designed as to be dished in cross-section asin FIG. 2 and to have their openings, which are shown as longitudinalgrooves 18, opposite one another. With this embodiment, the bindingthread could be drawn against the Fallopian tube around which it was tobe bound without the appliance being opened beforehand.

It is possible to use relatively thick thread material in the form of astrip or the like as the binding element. With elements of this type theloop surrounding the Fallopian tube is generally secured with a specialpinching member. Thread materials may, of course, also be consideredwith which the binding loop is secured simply by knotting.

The previously mentioned path-finder probe for threading through thebinding element may for example consist of a nylon thread to which awoven binding thread is secured. On the other hand, probes may also beconsidered in the form of metal coils or flat steel strips.

Finally, it is pointed out that, in the context of the invention,various departures may be made from the embodiment described above. Inthis way, the passage 5 need not begin and end directly at the extremeproximal end of the device since the beginning and end of the passagemay also be located in, amongst others, the side of the mounting 7. Inthis case the thread would be introduced into the passage from the side,either directly or via an auxiliary device.

Furthermore, the gripping arms may also be of any other desired shapebesides the enclosed configuration in FIG. 1 and the half-openconfiguration in FIG. 2, in which case an open configuration, that is tosay one with an outward facing concavity, has the advantage that it iseasy to withdraw the gripping arms over the Fallopian tube and the tworuns of thread. The opening could also be used for severing veins. Whenthe inner sides are, in fact, open, the gripping arms may remain in theclosed state while the inserted member, Le. a thread or possibly a thinsteel strip, is drawn out from the proximal end in order to perform theseparation.

It should also be pointed out that it is not absolutely necessary forthe free ends of the gripping arms to rest against one another when thedevice is in its normal state; they could rather be at a certaindistance from one another. In this case the thread passage would thus beinterrupted in the vicinity of the grips.

The possibility also exists of equipping the device with the bindingelement prior to the operation. Instead of a single element it wouldalso be possible to use two separate ones, each of which is introducedinto one of the two tubes which form the passage 5. A portion of thethread or other elements which projects from a gripping arm could thenbe connected to the adjacent thread by fusion or the like after theFallopian tube has been surrounded when the grip is closed, which, inprinciple, again produces a single continuous thread with a distal pointof connection.

I claim:

1. In a surgical device for effecting temporary sterilisation of femalesby binding the Fallopian tubes, which device comprises a barrel and animplement slidingly enclosed and received in said barrel comprising twore-' silient passage-defining means having a rearwardly extendingoperating portion and forwardly extending curned gripping arm portionswith ends opposing each other when in an extended position, and incontact with each other when in a retracted state, said passage meansbeing coextensive with the means in said arms to receive a bindingelement which passes through said gripping arms in their normally closedstate.

2. A device according to claim 1, wherein said passage begins and endsin the proximal section of said device.

3. A device according to claim 1, wherein, when said implement isclosed, said gripping arms exert outwardly directed tension and aredisplaceable in relation to an annular part which partly encloses themand bears against them externally.

4. A device according to claim 3, wherein said passage means areoutwardly biased end include two tubes fixed in a mounting which isaxially movable within said barrel in opposition to a spring mounted onsaid rearwardly extending portion, and the distal end of said barrel,which forms said annular part, bears against inclined faces on the saidgripping arms.

5. A device according to 4, wherein said spring is secured on the onehand to said barrel and on the other hand to said tube mounting.

6. A device according to claim 4, wherein said spring is formed fromstrip material into a gentle curve with at least approximately parallelsides, and forms a handle for opening said gripping arms.

7. A device as claimed in claim 1, wherein said gripping arms are dishedin cross-section and their openings take the form of longitudinalgrooves and are situated opposite one another.

1. In a surgical device for effecting temporary sterilisation of femalesby binding the Fallopian tubes, which device comprises a barrel and animplement slidingly enclosed and received in said barrel comprising tworesilient passage-defining means having a rearwardly extending operatingportion and forwardly extending curned gripping arm portions with endsopposing each other when in an extended position, and in contact witheach other when in a retracted state, said passage means beingcoextensive with the means in said arms to receive a binding elementwhich passes through said gripping arms in their normally closed state.2. A device according to claim 1, wherein said passage begins and endsin the proximal section of said device.
 3. A device according to claim1, wherein, when said implement is closed, said gripping arms exertoutwardly directed tension and are displaceable in relation to anannular part which partly encloses them and bears against themexternally.
 4. A device according to claim 3, wherein said passage meansare outwardly biased end include two tubes fixed in a mounting which isaxially movable within said barrel in opposition to A spring mounted onsaid rearwardly extending portion, and the distal end of said barrel,which forms said annular part, bears against inclined faces on the saidgripping arms.
 5. A device according to 4, wherein said spring issecured on the one hand to said barrel and on the other hand to saidtube mounting.
 6. A device according to claim 4, wherein said spring isformed from strip material into a gentle curve with at leastapproximately parallel sides, and forms a handle for opening saidgripping arms.
 7. A device as claimed in claim 1, wherein said grippingarms are dished in cross-section and their openings take the form oflongitudinal grooves and are situated opposite one another.